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NPI Code Detail

MEDICARE: JESSICA WIRTLEY

MEDICARE:   JESSICA  WIRTLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2015101OH

General Provider Information

NPI Number : 1114310976
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA WIRTLEY
Provider Business Mailing Address
First Line : 6116 HURSH RD
Second Line :
City : MIDDLETOWN
State : OH
Zip : 45042-8938
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9680 CINCINNATI COLUMBUS RD
Second Line :
City : WEST CHESTER
State : OH
Zip : 45241-1071
Country : US
Telephone Number : 513-777-8599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2015
Last Update Date : 03/17/2015

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Directions to “ JESSICA WIRTLEY ” Practice Location

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